Healthcare Provider Details

I. General information

NPI: 1588053193
Provider Name (Legal Business Name): ERIC W DOSS MFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/20/2015
Last Update Date: 01/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3108 SE 30TH CT
MOORE OK
73165-7379
US

IV. Provider business mailing address

3108 SE 30TH CT
MOORE OK
73165-7379
US

V. Phone/Fax

Practice location:
  • Phone: 813-451-0121
  • Fax:
Mailing address:
  • Phone: 813-451-0121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: